Can we stop immunomodulatory treatments in secondary progressive multiple sclerosis?

J. Bonenfant 1 E. Bajeux 1 V. Deburghgraeve 2, 1 E. Le Page 2, 1 G. Edan 3, 2, 4 A. Kerbrat 4, 3
3 VisAGeS - Vision, Action et Gestion d'informations en Santé
INSERM - Institut National de la Santé et de la Recherche Médicale : U1228, Inria Rennes – Bretagne Atlantique , IRISA_D5 - SIGNAUX ET IMAGES NUMÉRIQUES, ROBOTIQUE
Abstract : BACKGROUND AND PURPOSE: The benefits of immunomodulatory treatments in secondary progressive multiple sclerosis (SPMS) are unclear, calling into question their continuation. In the present observational study, we investigated the effect of treatment withdrawal on the clinical course of SPMS. METHODS: We included 100 consecutive patients with SPMS who regularly attended our multiple sclerosis clinic. Inclusion criteria were (i) secondary progressive phenotype for at least 2 years, (ii) immunomodulatory treatment for at least 6 months and (iii) treatment stopped with no plans to switch to another. Clinical and magnetic resonance imaging (MRI) data before and after treatment discontinuation were assessed. Factors associated with relapses and/or MRI activity were identified. RESULTS: Mean treatment duration was 60.4 ± 39.3 months, and mean follow-up duration after treatment withdrawal was 62.4 ± 38.4 months. The annualized relapse rate remained stable at 1 and 3 years after treatment withdrawal [0.09, 95% confidence interval (CI), 0.05-0.17 and 0.07, 95% CI, 0.05-0.11, respectively], relative to the 3 years prior to treatment withdrawal (0.12, 95% CI, 0.09-0.16). Sixteen patients experienced a relapse and 19 had a gadolinium-positive MRI scan without relapse during follow-up. A gadolinium-positive MRI scan within the previous 3 years before treatment withdrawal and Expanded Disability Status Scale score of <6 were positively associated with relapse and/or MRI activity after discontinuation (P = 0.0004 and P = 0.03, respectively). CONCLUSION: In this retrospective study, including a limited number of patients with SPMS, the annualized relapse rate remained stable after treatment withdrawal, relative to before treatment withdrawal. Further prospective studies are needed to confirm this result and provide evidence-based guidelines for daily practice.
Type de document :
Article dans une revue
European Journal of Neurology, Wiley, 2017, 24 (2), pp.237-244. 〈10.1111/ene.13181〉
Liste complète des métadonnées

https://hal-univ-rennes1.archives-ouvertes.fr/hal-01484970
Contributeur : Laurent Jonchère <>
Soumis le : mercredi 8 mars 2017 - 09:33:29
Dernière modification le : jeudi 14 février 2019 - 08:28:02

Identifiants

Citation

J. Bonenfant, E. Bajeux, V. Deburghgraeve, E. Le Page, G. Edan, et al.. Can we stop immunomodulatory treatments in secondary progressive multiple sclerosis?. European Journal of Neurology, Wiley, 2017, 24 (2), pp.237-244. 〈10.1111/ene.13181〉. 〈hal-01484970〉

Partager

Métriques

Consultations de la notice

282